Resilience as a Protective Factor Against the Exacerbating Effects of Common Psychiatric Comorbidities on Depression

Depression is associated with worse clinical outcomes when comorbid with anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances. Many affected individuals experience barriers to accessing adequate care, especially in low- to middle-income countries (LMICs). Psychological resilience can protect against psychiatric symptoms, especially in the context of comorbidity, and can be enhanced through various learnable cognitive-behavioural strategies. This study examined whether psychological resilience may mitigate the worsening of depressive symptoms associated with anxiety, PTSD, and sleep disruption and evaluated which component(s) of resilience (Positive Affect, Stress Mastery, and Early-Life Stability) may be the strongest predictors of any protective effect. A total of 291 young adults completed an online survey measuring symptoms of depression, anxiety, PTSD, sleep disturbance, and resilience. Regression analysis showed that resilience significantly moderated the relationship between current symptoms of anxiety and depression, but there was no such moderation effect regarding the influence of PTSD symptoms and sleep disruption on depressive symptomatology. Furthermore, the Positive Affect and Early-Life Stability components of resilience were responsible for the moderation effect. Positive Affect consists of several learnable cognitive and emotional skills, underscoring that building psychological resources may enhance mental health in LMICs. However, Early-Life Stability is less malleable and emphasises the need for systemic and social improvements to the circumstances in which many children in LMICs are reared to enhance their adult mental health.